Designed to meet the needs of low-income, elderly and disabled Americans, the Medicaid program was unveiled in 1965 to provide access to health services as a part of the Social Security Act. The federal government provides a portion of the funding to state governments, which administer the program and enroll their qualified residents into the program. Serving nearly fifty million people annually, the Medicaid program consumes a large portion of state and local budgets in administration costs and payments to health providers.
Individuals needing services from Medicaid apply directly to the program in their state. Although the state programs are overseen by the federal Centers for Medicare and Medicaid Services, each state program differs in the way that applicants are approved, the types of services that are provided, whether or not participants are required to co-pay and even the names of the programs. While most states simply refer to the program as Medicaid, some states re-brand the program with names such as “MassHealth” or “TennCare.” With the rising popularity of free-state provided insurance for children, some state governments have opted to combine these SCHIP (State Children’s Health Insurance Program) to save on administration and provide a central place for information for residents.
Many people confuse Medicaid programs with the federal Medicare program provided for elderly individuals. While the elderly are eligible for Medicare based solely on having attained the age of 65 — with exceptions provided for the disabled — only individuals meeting specific poverty guidelines qualify for Medicaid. Medicare provides a variety of options to cover hospital, medical examination or prescription coverage for individuals meeting the age requirement. For low-income seniors, Medicaid and Medicare coverage can be combined to provide a fuller level of coverage. Because of the means testing associated with Medicaid, as opposed to Medicare, Medicaid provides a greater level of coverage to the neediest Americans.
For children, Medicaid provides not only medical services, but also dental screenings and the restorative services associated with the findings of the dental screening. These services are provided as part of the Early and Periodic Screening, Diagnostic and Treatment program provided to Medicaid eligible children to provide early detection and prevention of some common medical conditions affecting children and youth, particularly chronic conditions that can result in abnormal development and delayed or obstructed growth. With early dental treatment critical to preserving the future dental health of children, the Early and Periodic Screening, Diagnostic and Treatment protocols ensure that children receive regular dental screening, cleaning and access to a consistent source of restorative care. For adults over the age of 21, these dental services are available as an option in their medical services.
Medicaid services are available for those meeting poverty guidelines who also meet an additional qualifying criterion, such as citizenship, pregnancy status, family size or disability, among others. The services are provided to the neediest individuals meeting one of those eligibility factors, with exceptions provided in cases of emergency. As a part of the Social Security system, Medicaid offers a social safety net for those who are unable to earn money to pay for their medical needs and lack the necessary assets to provide for their own medical or dental care. As a result, Medicaid ensures that the most vulnerable members of the population are provided with a safe, regular and consistent source of access to the medical care needed to preserve their quality of life.
While senior citizens can obtain medical coverage through Medicare, this coverage does not cover the costs associated with nursing home care for those who require it. For those elderly Americans who cannot afford to pay for nursing home care, but are no longer capable of living independently or without the assistance of a nurse, Medicaid provides nursing home coverage based on asset levels. Taking advantage of this coverage requires that the senior citizen surrenders all but $30 of his or her income to the Medicaid program, with that money being used for program funding in paying for all associated costs of nursing home care.
The strict rules regarding asset limits and means testing with Medicaid nursing home care has spurred a cottage industry of lawyers and accountants specializing in helping senior citizens legally redirect or gift some assets in advance of their application to their state program, preventing those assets from being considered in their application and having a lien placed against their house or other property for payment of the nursing home expenses. Recent rule changes, however, have made this a greater challenge, as the program now reviews all gifts and assets transfers for the five years prior to the application to the Medicaid program and imposes a penalty for gifts and transfers made within that five year period. This can result in seniors requiring nursing home care, but being left to pay an amount equal to funds that they no longer have control over.
The future of Medicaid has been continually called into question with the fragility of state governments and the federal budget and its fate is often tied very closely with that of Social Security. With the millions of people dependent upon this program for their continuing maintenance of health conditions, particularly for impoverished Americans living with AIDS who might otherwise have no way of procuring the treatment necessary for battling their severe illness. Providing this coverage to so many needy individuals currently comes at a cost of nearly $300 billion each year, with $200 billion of that being spent by the federal government. Federal matching funds subsidize the poorest states at a larger percentage than wealthier states in an attempt to compensate for the challenges faced by state budgets, while providing a consistent level of care across the nation.